How to introduce the All-on-4® treatment concept to your practice: 8 tips from clinicians

All-on-4® treatment concept procedure: 8 ways for a smooth start

Embarking upon a new treatment and ensuring it becomes a successful solution for your patients can be challenging for any practice. The All-on-4® treatment concept is the leading treatment for edentulous or soon-to-be-edentulous patients, and if you’re considering it for your practice you will undoubtedly have many questions. To help you, clinicians from around the world share their advice and experiences for a smooth and successful start with the All-on-4® treatment concept.

Surgeons – it’s crucial you understand every phase of the protocol.

Dr. Joshua E. Gish DDS, Oral and maxillofacial surgeon, US

It is crucial for the surgeon looking to include the All-on-4® treatment concept in his or her practice to understand the planning, surgical and restorative phases of treatment. Although full-arch restorations are restoratively driven, the comfort level of your restorative referrers and the success of patient case acceptance is directly related to a comprehensive understanding of the protocol by the surgeon. The All-on-4 protocol should be implemented as an efficient treatment partnership that is expertly coordinated between the patient, restorative dentist, surgical specialist, implant manufacturer and local laboratory.

Raise awareness of your All-on-4 offering with hands-on sessions

I’ve had great success incorporating the All-on-4® treatment concept into my practice and raising awareness through small hands-on group sessions. During these sessions, I present the protocol to a small group of restorative doctors while physically demonstrating the implant connection, multi-unit abutments and restorative components. Once the referring doctor has completed a case with me, they are then invited to a quarterly dinner meeting where we have a group discussion about our All-on-4 cases. Here we discuss what we find to be helpful in improving patient acceptance, what improvements we have made to the protocol to increase efficiency and we present new prosthetic advances with help from our laboratory.

All-on-4 is all about teamwork

It is not always easy to prepare as treatment can be complicated, but with proper teamwork and progressive improvements you can deliver successfully.

In the beginning, I highly recommend working with a technician who has experience in the All-on-4® treatment concept and can provide on-site support. Arrange meetings with the personnel involved – surgery assistants, technicians and product specialists, and ensure to prepare all patient records, implant components, and lab work beforehand.

As you progress, continue to learn from experts in the All-on-4® treatment concept – you could acquire valuable skills and business ideas from various workshops and specialized centers with your team. For complex cases, it is advisable to work with other experts (experienced clinicians, oral surgeons, prosthodontists and periodontists) where each member can contribute according to their expertise.

Dr. Ian Yip: All-on-4 is all about teamwork

Collaboration is crucial – and we do it ‘All On Friday’

Dr. Teri Gaddy DDS, General practitioner, US

Collaborating with other specialists I feel is crucial to ensuring a smooth transition on your journey to the All-on-4® treatment concept.

I attend the ‘All On Friday’ program, hosted by Dr. Naples in Seattle. A small group of dentists come together once a month to work exclusively on All-on-4® treatment concept cases, working on any number of steps in the conversion sequence, and with a lab technician present to offer his opinion on esthetics and fabrication. His staff are fully trained in the All-on-4® treatment concept and assist less experienced clinicians. It is a unique setting to familiarize yourself with each step in the process before introducing the concept to your own patients – and as many times as it takes to make you feel comfortable.

It also allows you to see potential complications and how they are resolved. For example, where it has been discovered that a multi-unit abutment needs to be rotated to a different position, or excess tissue has had to be removed from around the healing abutment, these procedures have been easily achievable.

This collaboration has been an invaluable asset in giving me the confidence to offer this treatment to my patients.

Avoid surprises by using digital treatment planning

Image courtesy of MALO CLINIC

Mariana Alves DDS, MALO CLINIC Dentist, Portugal

When starting to use the All-on-4® treatment concept I would now advise using NobelClinician Software. This tool supports you in performing a diagnosis, and allows you to create a treatment plan and communicate better with your patient.

To perform the All-on-4 procedure, you have to understand that a meticulous treatment plan is very important when informing your patient of the best solution. Digital treatment planning provides a careful strategy – avoiding surprises during surgery and determining the ideal implant placement based on bone quantity and quality.

At the start of a case, issues regarding critical anatomical structures, and whether or not immediate function is achievable, are perfectly normal. Complications will happen, but with the right knowledge and careful treatment planning, they can be minimized.

After placing unitary implants it’s normal to feel the need to jump straight into total rehabilitations. It is challenging, so wait until you’re prepared.

Get started with hands-on training

I have always sought opportunities for the best quality service for our patients and with the least discomfort. My first experience of the All-on-4® treatment concept was at a Nobel Biocare event in 2004 and since then I have been closely following the rapid growth of the concept around the world.

Before starting, it is important for any implantologist to take hands-on training in the All-on-4® treatment concept. This includes experienced practitioners who will also need to learn new details and intricacies. Once you are comfortable with the All-on-4® treatment concept, the grateful patients will motivate you to offer it in the right cases.

Nobody is immune to risks and complications and following the detailed protocol closely not only decreases risks but also helps obtain predictable outcomes. Also, I advise you to present clinical cases to more experienced colleagues. Collect patients’ medical histories carefully; conduct X-rays and CT scan exams and plan the case in NobelClinician. Move forward with the innovations!

The All-on-4® treatment concept in practice at the surgery of Prof Reshetnikov

Be sure that you have the surgical expertise

Dr. Vikas Dhupar, Oral and maxillofacial surgeon, India

The All-on-4® treatment concept is a great technique in situations indicated, but be sure that you have enough surgical expertise. For surgeons, confidence in placing implants on a regular basis is the foundation you need. Most critical is to understand the local anatomy and angulations these implants are placed, but surgeons must also be well familiarized with the prosthetics.

Hands-on training is a great way to start clearly understanding the technique, familiarizing you with concept and components, and the techniques – both surgical and prosthetic. Depending on surgical experience, guidance from more experienced practitioners may be required; for the most effective use of the All-on-4® treatment concept, build a team for such cases.

Inform patients well, select them with care

Dr. med. dent. Melanie Grebe, Implantologist, Germany

For patients, we host regular information evenings where we share the many possibilities now available as alternatives to removable teeth, and patients come to me specifically requesting the revolutionary All-on-4® treatment concept. Some of them have had healthy teeth remaining, which they are happy to have extracted. However, at our practice located in Germany, we must save natural teeth whenever possible. Be aware of any such requirements that may impact your offering of this treatment, and select cases with care.

From a logistical point of view, I am a surgeon but we also perform prosthetics in our practice, and our own dental laboratory is located nearby. These are good practical ways that help us realize teeth in a short time. We also love planning treatments using NobelClinician planning software.

Finally, you don’t have to be left alone to make mistakes and lose confidence in what is an ingenious technique! I had the chance to spend two weeks at the side of Paulo Malo to take a look ‘behind the scenes’, where I could ask any questions, see many patients, and the workflow performed from start to finish. After this experience I was perfectly prepared for my own practice.